About the Sports Concussion Program

Overview

The Sports Concussion Program at Dartmouth-Hitchcock applies the expertise of sports medicine specialists, neuropsychologists, athletic trainers, and nurses to provide the highest level of care and management for sports related concussion. If needed, our team can collaborate with additional concussion care experts in the fields of physical therapy, neurology, and neurosurgery. The Sports Concussion Program is open to athletes of any age who have had a concussion and want a defined assessment and management plan for return to sports, or recommendations for return to school. We also conduct baseline testing in the event that a concussion occurs in future. These test results will serve as a benchmark against which to measure the function of the brain following any future concussion. The Sports Concussion Program is not intended to be the first point of care for someone who has sustained a more serious traumatic brain injury, such as a bleed in the brain, skull fracture, or an injury that affected cranial nerve or motor function.

There are two stages to the services offered through the Sports Concussion Program: baseline testing and post-concussion management.

Baseline testing

Experts recommend that athletes who regularly participate in contact sports have baseline testing done prior to the start of a sports season. In most children younger than 13, baseline testing will not be useful due to ongoing maturation and developmental factors. This concept is reflected in the most current research literature.

Baseline testing includes neurocognitive and balance tests and should be done once every two years. If you would like baseline testing, you will come to Dartmouth-Hitchcock (available at the Lebanon, Concord, and Manchester locations) to meet with one of our nurses or athletic trainers. This visit will include three components: concussion history, balance assessment, and neurocognitive testing. To assess your balance we utilize the Balance Error Scoring System which is a simple and easy assessment that is conducted in the office. The neurocognitive test is called ImPACT™ and it measures your verbal memory, visual memory, processing speeds, and reaction times. The results of these tests will be saved in a secure database so they are available in the event that you sustain a concussion in the future. The appointment for this testing will take about one hour and costs $25.00 per athlete. Payment can be made in the form of cash or check, and is not billable through insurance at this time. The Sports Medicine clinic staff are also available to come to schools for consultation and educational presentations, or to conduct baseline testing with a group in a computer lab. If you are interested in more information or cost structure for group baseline testing, please contact the Lebanon clinic location at the number listed below.

Post-concussion management

If you have a suspected concussion, we would like to see you at least 24 hours after the concussion occurred, preferably no more than one week after the concussion. This time period will allow your symptoms to subside slightly and perhaps you will regain some of your function. . For the first 24-48 hours after your injury you should allow your brain to rest, physically and mentally. Some general recommendations are to avoid electronics on small screens (such as smartphones), avoid mental challenges that seem difficult or trigger your symptoms, and get plenty of quality sleep at night and with naps during the day if needed. Emerging research is demonstrating that too much cognitive rest for longer than 48 hours after injury may not be beneficial, and in fact may be detrimental to your overall recovery. Please note that misconceptions such as waking an injured person throughout the night are untrue and can actually be harmful. Be sure to limit activities that cause symptoms, such as headaches or dizziness. This includes refraining from activities such as video games, computer work, television, or texting if they cause your symptoms to get worse. Try to keep a regular schedule and get a full night of sleep. Be sure to write down your symptoms until you see our team.

On your appointment date, you will come in for a physical exam by one of our specialists. He or she will ask you about your concussion history, any changes you've noticed in your daily functions like sleeping, eating, or your moods, and what symptoms you've been experiencing. They will also want to know what activities seem to trigger your symptoms. At that time, you will do your neurocognitive and balance testing. If you have completed baseline testing, our providers will assess if there is any change from your baseline scores for visual, verbal, cognitive, balance, and behavioral functions. If you do not have baseline testing results in your file, your results will be compared to standard scores for people in your age category. Your test results will be read immediately by one of our specialists. The combined results of your physical exam and neurocognitive testing will guide our plan of care for your concussion, including how to safely resume physical and cognitive activities. You may be asked to stop doing physical and mental activities that cause your symptoms to reappear until your brain has demonstrated more recovery from your injury.

In certain instances, a referral may be needed to another specialist at DHMC to manage and treat ongoing symptoms. Our team prides itself on exceptional communication amongst providers and between a patient’s providers and educators back at home. We value a team-based approach to concussion management that has been advocated for by multiple professional health care associations and in academic literature on concussion.